World Journal of Medical Sciences 1 (2): 112-116, 2006 ISSN 1817-3055 © IDOSI Publications, 2006 Corresponding Author: Dr. Arshad M. Malik, Assistant Professor of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan 112 Different Surgical Options and Ileostomy in Typhoid Perforation Arshad M. Malik, Abdul Aziz Laghari, Qasim Mallah, Ghulam Ali Qureshi, Altaf Hussain Talpur, Sadia Effendi and Jan Mohammad Memon Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan Abstract: To find out the value of primary ileostomy as a life saving procedure in patients of typhoid ileal perforation. 112 diagnosed cases were included in this study with a mean age of 18.66 years with a male to female ratio of 1.5:1. After diagnosis and resuscitation, all of the patients were operated within 48 h of admission. The operative procedure was determined by the general condition of the patient, number of perforations and degree of peritoneal contamination. Primary ileostomy was done in moribund patients with massive faecal contamination of peritoneal cavity, while primary double layered closure of the perforation was attempted in clinically stable patients with a single perforation and resection followed by end- to- end anastomosis was attempted in cases where there were more than one perforations or the perforation was present too close to the ileocaecal junction. Age ranged from 8 years to 50 years and the maximum number of patients were in the age group 31-40 years, with a male dominance. On laparotomy 98 (88.5%) patients had a solitary perforation in the terminal ileum and 14 (12.5%) patients had more than one perforation. Primary double-layered closure was done in 40 (35.71%) patients; primary ileostomy in 54 (48.21%) patients and resection followed by end-to-end anastomosis was done in remaining 18 (16.07%) patients. Faecal fistula was the most dreaded and fatal complication and was found to be commonest in patients where primary closure was done (07, 17.55). Over all mortality was (7.14%) of which 6 (5.35%) died secondary to the development of faecal fistula while one patient developed severe peri-stomal excoriation and progressive malnutrition leading to septicemia and death. Minimum hospital stay was associated with primary ileostomy patients and so was the complication rate. Primary ileostomy was found to be superior to other surgical procedures as far as the morbidity and mortality is concerned and especially so in moribund patients presenting late in the course of illness, where it proved to be a life saving procedure. We recommend that primary ileostomy is a safe way of managing typhoid ileal perforation. Key words: Typhoid perforation primary ileostomy primary closure resection anastomosis INTRODUCTION factors influence overall prognosis and outcome of Typhoid fever is a life-threatening problem in adequate pre-operative resuscitation, delay in surgery, Pakistan especially due to the emergence of multiresistant number of perforations and degree of faecal strains of salmonella typhi [1]. Intestinal perforation is contamination of the peritoneal cavity [12, 13]. The one of the most dreaded and common complication of present study was conducted to compare the results typhoid fever, remarkably so in the developing countries of different surgical techniques employed in typhoid where it usually leads to diffuse peritonitis [2-5]. It was perforation in terms of overall morbidity and mortality considered to be an almost fatal condition in the past and and to find out the role of ileostomy as a life saving the mortality and morbidity still remains very high despite procedure especially in moribund patients presenting remarkable improvements in the surgical management. late in the course of illness and having heavy faecal The current surgical options include primary double contamination and diffuse peritonitis. layered closure [6], segmental resection and end- to- end anastomosis [7] and primary ileostomy [8, 9]. Studies MATERIALS AND METHODS with controversial outcome [10, 11] have been published and there remains a difference of opinion as to the best One hundred and twelve patients with typhoid surgical procedure in typhoid ileal perforation. Various perforation were admitted and treated between June 2003 surgical treatment such as delayed presentation,